MCOs (FL)- AHCA releases invitation to negotiate for Statewide Medicaid Managed Care Program


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[MM Curator Summary]: The FL bid has dropped. Ready, set, Go!



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Shane Ersland | Apr 12, 2023 | Florida

The Florida Agency for Health Care Administration (AHCA) released an invitation to negotiate for the upcoming new Statewide Medicaid Managed Care Program (SMMC) contract on Tuesday.

Most Medicaid recipients in Florida are enrolled in the SMMC, which covers 4.4 million individuals, and consists of:

  • Managed Medical Assistance (MMA), which provides Medicaid-covered medical services like doctor visits, hospital care, prescription drugs, mental healthcare, and transportation for these services. Most Medicaid recipients receive their care from a plan that covers MMA services.
  • Long-Term Care (LTC), which provides Medicaid LTC services like nursing home, assisted living, or home care. LTC recipients must be at least 18 years old, and meet nursing home level of care requirements (or meet hospital level of care requirements if they have cystic fibrosis).
  • Dental, which provides all Medicaid dental services for children and adults. All people on Medicaid must enroll in a dental plan.

This will be the second SMMC re-procurement since the program began in 2013. Current contract holders include Centene, Community Care Plan, CVS/Aetna, Elevance Health, Florida Community Care, Humana, Molina, and UnitedHealthcare.

Current contracts began in December 2018 and were slated to run through 2024. The  new contracts will run from Oct. 1st, 2024, through Dec. 31st, 2030.

The upcoming procurement will award contracts for MMA and LTC. Proposals are due on Aug. 15th, and the anticipated award date is Dec. 11th.

Important deadlines for the process include:

  • May 3rd: deadline for the receipt of written questions
  • June 27th: anticipated date for agency responses to written questions
  • Aug. 15th: deadline for receipt of responses; public opening of responses
  • Aug. 17th: anticipated posting of respondent names for provider comment
  • Sept. 5th: deadline for receipt of provider comments
  • Oct. 2nd through Nov. 17th: anticipated dates for negotiations
  • Dec. 11th: anticipated posting of notice of intent to award

The agency intends to award contracts to nationally accredited managed care plans that: 

  • Incentivize value and quality
  • Offer an enhanced service delivery system and integration of behavioral and physical health services
  • Ensure the availability of comprehensive, quality-driven provider networks
  • Streamline processes that enhance the enrollee and provider experience 
  • Provide expanded benefits targeted to improve outcomes for enrollees
  • Have top quality scores and high rates of enrollee satisfaction
  • Are able to deliver an efficient, high-quality, innovative, cost-effective, integrated healthcare delivery model
  • Provide pathways towards self-sufficiency, purpose, and independence   

The anticipated term of the contract will begin from the date of the contract’s execution through Dec. 31st, 2030. The contract cannot be renewed, however, the agency may extend the resulting contract’s term to cover any delays during the transition to a new plan.